Easy set Q-2 - katieusmle

[ArchivalUser]

A 38-year-old woman is seen by a gynecologist on a routine visit. A complete history is taken and is non-contributory except for the fact that the patient's menstrual irregularities apparently developed insidiously over the preceding decade. Screening physical examination is performed. Routine serum chemistries and complete blood count are sent, as are Pap smear studies. Pelvic ultrasound studies are also performed. Pregnancy test is negative. Endometrial biopsy shows proliferative endometrium. All other results are within normal limits, except for evidence of a mild iron deficiency anemia.

Question 1 of 3: Which of the following is the most likely diagnosis?
A. Cervical carcinoma
B. Cervical dysplasia
C. Dysfunctional uterine bleeding
D. Endometrial carcinoma
E. Turner syndrome

Question 2 of 3: In most patients with this patient's disease, the condition is etiologically related to which of the following?
A. Anovulatory cycles
B. High androgen levels
C. High progesterone levels
D. Persistent corpus luteum
E. Persistent secretory endometrium

Question 3 of 3: The physician decides to treat this patient with an oral drug that will stop endometrial growth and support and organize the endometrium to allow organized sloughing on the next menstrual cycle after withdrawal of the drug. Which of the following is the most appropriate pharmacotherapy?
A. Estrogens, conjugated
B. Glyburide
C. Hydralazine hydrochloride
D. Levothyroxine
E. Medroxyprogesterone acetate

[ArchivalUser]

1-c
2-a
3-e

[ArchivalUser]

yup...
C
A
E

[ArchivalUser]

1...The correct answer is C. This patient most likely has dysfunctional uterine bleeding. Other, potentially more serious, diseases have been mostly excluded by the patient's extensive evaluation (more than many patients receive in this setting).

22..The correct answer is A. Approximately 90% of patients with dysfunctional bleeding have anovulatory menstrual cycles. In these patients, the failure of ovulation leads to a failure of the corpus luteum to form (compare with choice D), and consequently a failure of normal progesterone secretion (compare with choice C) and a failure to develop secretory endometrium (compare with choice E). Estrogen levels remain high but androgen levels (choice B) do not usually play a significant role. The unopposed estrogen secretion stimulates endometrial proliferation, and the thickened endometrium eventually outgrows its blood supplies and begins to die, producing the prolonged menstrual blood flow. In the remaining 10% of patients who have dysfunctional uterine bleeding and ovulatory cycles, the prolonged progesterone secretion is associated with irregular endometrial shedding. Some of these latter patients also have polycystic ovary disease and may have abnormal androgen metabolism.

3...The correct answer is E. Medroxyprogesterone acetate (Provera) is the drug of choice for most patients with anovulatory dysfunctional uterine bleeding. It does not control the acute episode of bleeding, but it does allow the establishment of a more stable endometrium, and the bleeding following the withdrawal of the Provera usually has a more normal character.

[ArchivalUser]

C
A
E